The Cobra

We who work in the medical field know that we may deal with unpleasant realities on any given day.  People don’t usually come to the doctors’ offices or clinics or hospitals to prove that everything is right in their world.  In fact, most of the time the reverse is true.  As a result of this hard truth, we medical workers develop an odd sense of humor in order to deal with the stress, much in the same manner as law enforcement agents or military personnel or others doing those jobs that most people wouldn’t want to do.  Some call it ‘gallows humor,’ and I suppose that is as good a description of it as any other.

But underlying that humor, we medical workers remember that we’re working on flesh-and-blood people; people who have lives and histories, families and connections and, probably most important, simple human worth.  We will work like fiends possessed in order to snatch a patient back from the grip of death, and if death has just been dealt too strong a hand we will sometimes cry and pound our fist against a wall when The Reaper wins the table.

It is with all of that in mind that I will now share a story from my medical career of over forty years.  I have no intention of making light of a person’s health crisis, and will refrain from stating the patient in my story’s age, medical diagnosis (which I never knew anyway), location, or anything else that could possibly identify this person or cause harm or pain to him or any living relative or acquaintance.  This is meant simply as a bit of humor; the humor that I and many who do work like mine use in order to keep our sanity.

This story is entitled ‘The Cobra,’ and it is with reference to the spitting cobra that is found in Africa and Southeast Asia.  It began when I was called to perform an ultrasound study of the abdomen on a patient in the Intensive Care Unit at a hospital where I worked years ago.  As usual, I loaded gel and linen on top of my ultrasound machine and pushed it to the room where the patient lay.

Outside the door was a cart with gowns and masks and bonnets which are usually provided when the patient has some disease such as MRSA, Clostridium difficile, E. Coli, or any other such highly communicable disease.  As I was gowning up, the patient’s nurse came by and I asked her “What nasty bug am I protecting myself from today?”

“Oh” she replied.  “He doesn’t have any infectious disease that we know of.”

I looked at the cart and bright yellow gown that I was wearing and then asked the nurse “Then why am I wearing all of this?”

“He spits” she said.

“Pardon me?”

“The patient spits.  It’s a neurological thing.  We don’t even know if he’s aware that he’s doing it.  He isn’t aiming, as far as we can tell, and you’ll only get hit if you stray into his line of fire.  He just spits constantly, so this is for your protection.”

I had never heard of any such thing, and so with a mix of caution and doubt I pushed my machine into the patient’s room and set up to go to work on the right side of the bed.  I quickly sized up the situation.  The floor was indeed a swamp of spit.  His bedding had recently been changed, so there was only a general dampness to the sheets and blanket that covered him.  His head was turned to the left, so I plugged in my machine, pulled up my chair, lowered the blanket and raised his gown, and then began to scan according to my abdomen protocol.

“Left lobe of the liver; four pictures in the transverse plane, including the portal vein.  Now three views in sagittal, trying to capture the caudate lobe framed by the left lobe and the inferior vena cava.”

Just about as I snapped that last picture The Cobra, which name I gave to the patient as a part of the coping mechanism that I have explained above, began to slowly move his head from his left to his right, where I was sitting.  “Pffft!  Pffft!  Pffft!”  “Oh crud” I thought.  “They’re right!  He’s spitting and he’s turning toward me!”  

In Vietnam I had seen things coming my way; things that I had little or no ability to prevent.  In such circumstances I had to focus on survival, and so it was on this day.  “Think, Durden.  Think fast!”

The Cobra’s face passed the 90 degree mark and his liquid missiles were beginning to arc onto the right half of his bed.  My peril was undeniable and my reason nearly failed me.  At the last minute however inspiration broke through and took charge of the situation.

“Look” I said, pointing to the wall near the left side of his bed.  “What’s that?”

Gradually, by microscopic increments like slow motion on barbiturates, The Cobra’s head stopped its starboard progress and reversed course, and like a supertanker making a U-turn he began to roll his head to port in order to investigate whatever it was that I was pointing at, spitting all the while like a fireboat at a Fourth of July celebration.

I resumed my exam with a new sense of urgency.  Pancreas: Bam! Done!  Aorta: Bam! Done! Gallbladder: Well, sort of like a Bam!  Those things just take a little more time.  Then on to the right lobe of the liver, with many segments and structures, veins and ducts and such to evaluate.  The liver will slow you down, and time was not on my side.  Sure enough, before my last liver image was taken the fount of saliva began to once again track back to the right.  This time, however, I felt like I had a handle on the situation; it was that or I was cutting the exam short.

“Look” I said again, and with greater urgency this time, just in case he was catching on to me.  “What’s that?”  Again I pointed to the left and again, after almost getting my outstretched right hand spat upon, his head returned to a leftward arc, dousing that side of the bed, the floor, and the wall with a saliva rain.

Now I knew that I had this one in the bag.  I finished the liver and right kidney and began to shut down my machine.  This process didn’t take long and before The Cobra could turn to anoint the right side of the room I was outside, peeling off my isolation gear safe and dry and feeling pretty good about myself.

“How did you manage that?” asked a nurse as I snugly dropped my dry gown and gloves into the appropriate receptacle.

“Manage what?” I asked, being a confirmed and determined smartass.

“How did you stay dry?  Nobody else has done that.”

“Hey, no problem” I replied.  “Desperate times, desperate measures.  I used a decoy.”

I left the nurse scratching her head as I descended to our department to develop my film and show a pretty good study to the radiologist.

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